Cityfax Reporting Services Inc.

Automated Market Value Report (Desk Top) Order Form

Automated Market
Value Report
("DeskTop")
$78.75
Total Cost
INCLUDES:
G.S.T.
and all
Disbursements

Automated Market
Value Report
("DeskTop")
Plus
Property
Sub-Search
$131.25
Total Cost
INCLUDES:
G.S.T.
and all
Disbursements

Your Name and Contact Information
Fields marked with an * are required

Your name and contact information:
Your Firm Name (If Applicable)
Your Full Name *
E-mail Address *
Telephone (w/ area code) *
Fax (w/ area code)
Full Mailing Address *
How do you wish to receive your Automated Market Value Report(s)("DeskTop")
by Email by Mail by Fax Pick-up

Choose What Service you Want:

Automated Market Value Report (DeskTop) Only    Automated Market Value Report (DeskTop) & Sub Search of Title:

Reason for Automated Market Value Report(DeskTop):
         Relocation

         Financing/Refinancing

         Sale/Purchase

         Matrimonial

         Estate

         Other (please specify)

Fill in the Property Information/Search Criteria:

Your Reference No.

First Name

Middle Name

Last Name

Property Address

City

Province

Estimated Value

Legal Description
(if available)

Special Instructions

Contact Number

Payment Information

We're ready to perform the Automated Market Value Report (DeskTop)) you have requested,
we just need your credit card information. This is a secure transaction.
Once approved, we will process your request.

If you're ready with your credit card information, we're ready to proceed.

Credit Card: Please check off which card you're using. :


Name as it appears on Card : *

Credit Card Number : *

Expiry Date on Card :*
Month
Year

Client Consent

I
     First           Middle           Last
     Name         Initial            Name

hereby confirm that the information as provided is complete, accurate and correctly reflects "Services" required. I have read, understand and/or agree with the Terms of Service Agreement and Cityfax Privacy Policy.
I do authorize the above order and the Cityfax charges to be processed on the credit card, as provided.
Further, by pressing "Submit" button I/we consent to the collection, use and disclosure of information; provided to Cityfax, for the sole purposes of completing "Services Requested". This could involve disclosure to various Federal/Provincial authorities, responsible for administering programs and/or data files.